Concept of Equity of Access in the Australian Healthcare System - Essay Example

?The Australian Health care system is founded on the concept of equity of access. Discuss this ment with relation to the concept of effectiveness and efficiency and any interrelationships that may exist. Introduction The World Health Organisation has observed that inequities still exist in access to health in spite of overall improvement in health care delivery (WHO, 2008). The barriers to access must be addressed by additional reforms to reach the socially stratified people for whom service availability and social protection have no relevance (WHO, 2008). Equity in access to health care refers to the equal status in health among people regardless of their socio-economic statuses. (Braveman, 2003). Identification of those people can be made through the use of census data using the criteria such as geographic, socio economic, epidemiological or clinical or through the use of Geographical Information Systems (GIS) or ambulatory care sensitive condition hospital admission data (Muecke, 2010). Australian initiatives The National Health and Hospital Reform Commission (2008) and the National Health Performance Framework (2004) have given rise to the following principles for delivering improved healthcare to rural and remote populations. Accordingly, the services should 1) be accessible and equitable in that services should be need based and payable consistent with paying capacity. 2) be needs based and should be sensitive to cultural differences, cultural diversity and choices 3) ensure early intervention aimed at maintaining wellness, prevention of illness and achieving optimal health. 4) aim at comprehensives of services through coordinated services of diverse specialists in the wake of incidence of chronic diseases, 5) ensure safety and quality of health care which should be appropriate, in time and effective consistent with the best available evidence, 6) be efficient by minimising cost and maximising value, 7) be sustainable and 8) be based on the principle of accountability (Humphreys & Wakerman, n.d ). The Final report June 2009 of the health reform commission towards a better health for all Australians by tackling major access and equity issues prioritises five issues towards that end. 1) First, to improve the health outcomes for the Aboriginal and Torres Strait Islander people. 2) Second, mental health care to be improved. 3) Third, to extend support for those living in remote and rural areas. 4) Fourth, improved access to dental health care. And 5) Fifth, Quicker access to health care in public hospitals (DepartmentOfHealthandAgeing, 2009). Aboriginal and Torres Strait Islander population. This long neglected segment of the Australian population has caught the attention of the policy makers who have made determined efforts to give the top most priority for better health care delivery to these people. The Australian government have publicly apologised to these people. The intensity and sincerity of purpose to improve health outcomes to the First Australians living in isolation both in rural and urban areas have been unprecedented. Towards this end, a separate authority of National Aboriginal and Torres Strait Islander Health Authority (NATSIHA) has been formed. All the funding are aggregated and entrusted to this authority which is expected to utilise the funds for purchasing and commissioning the best available health care services. The services are expected to be effective, of high quality, appropriate to their culture and to meet the needs of these populations with a focus of the family and community of each member. Health care delivery does not mean treating illness alone. In order to promote their well being, their low nutrition intake has been targeted to be improved so as to close the health gap among these people. As a part of this initiative, vegetable and fruits hitherto unavailable to them owing to their remoteness are to be made available at their places of living at affordable prices (DepartmentOfHealthandAgeing, 2009). Serious mental illness The next priority has been accorded to the betterment of health care delivery to the people with serious mental illnesses. Sub-acute services are expanded and a ‘rapid response outreach team’ is available for round the clock response. This has been intended to provide intensive treatment at the community level in the place of hospital based treatment (DepartmentOfHealthandAgeing, 2009). People in remote and rural areas The third priority has been assigned to people living in remote areas. These people are eligible for universal health entitlement under Medicare but universal access has been denied to them for want of doctors in their areas. To rectify this anomaly, top-up funding on per capita basis for poorly served remote and rural population has been made available. The funding has been increased to meet the travel and accommodation needs of these people besides funding to make available adequate health work force and create opportunities for clinical training in those areas (DepartmentOfHealthandAgeing, 2009). Dental health care This is another neglected segment of health care delivery which has been accorded the fourth place in priority. Accordingly, Denticare Australia has been formed to provide basic dental services that include preventive and restorative services besides provision of dentures. It has been estimated that nearly one third of Australian adults cannot afford the high cost of dental services with the result they avoid or delay visits to the dental clinics. More than 650,000 people are already in the waiting lists of the public dental services. Children’s dental health has also been worsening. To address this problem of children, there are schemes of national expansion pre-school and school dental programs (DepartmentOfHealthandAgeing, 2009). Timely access to public hospitals The last in the priority is the issue of timely access to quality health care in public hospitals. In order to cut down the waiting time for the planned surgeries and other medical care, the Commonwealth Government has already earmarked $ 150 million every year until 2010-11. As soon as the waiting list is cut down to a large extent, funding will be available towards unmet need that will crop up after waiting list is fully met. Besides, extra funding is made available to meet requirement of additional beds in the public hospitals with emergency departments (DepartmentOfHealthandAgeing, 2009). Besides prioritisation, the department of health and ageing is also monitoring on a continuous basis to ensure people are able to access health services in time. National targets are recommended for primary health care services, mental health services, public hospital outpatient services, radiotherapy, planned surgery and emergency departments. Recently on 13 February 2011, the Council of Australian Governments has committed to work in tandem with National Health Reforms with a view to effect better health care delivery and have a sustainable health care system. Each State government has signed “a Heads of Agreement on National Health Reform” for materialising the said commitments (DepartmentOfHealthandAgeing, 2009). OECD health indicators The OECD of which Australia is a member country, has developed Health Care Quality Indicators (HCQI) which will help comparison of quality of care across the member countries of the OECD. Generally there has been a practice of incentivizing the performance of the healthcare systems of across the countries. Both the WHO and OECD have recommended the measurement of performance of healthcare systems mainly to address the issue of rising costs, ageing costs, market failures, poor quality of health care, medical errors, poor accountabilities and lack of equity in health care. There has been an impression that value of healthcare achieved does not match with money and effort spent. As such heath goals and health production are sought to be managed through performance measurement (Arah, Westert, Hurst, & Klazinga, 2006). Heads of agreements-National Health care reform The agreement envisages joint intervention at all the three levels of Commonwealth, State and Territory governments to improve health care delivery and sustainability of the health care systems of the country. They have agreed that reforms initiated will result in better health and better hospitals by ensuring that all the patients receive seamless care from across the different sectors of the health system. Higher performance standards, enhanced transparency and increased engagement of local clinicians will be set. Henceforth, there will be secured funding for health and hospitals. As part of achievement of nationally integrated and locally controlled health system , the Commonwealth and the States will share equally the cost of growth to be incurred for public hospital system. States shall act as systems managers for public hospital services. In the process, the state will be responsible for planning and performance of public hospitals, acquiring of public hospital services, planning, funding and delivery of capital and planning, funding along with the Commonwealth and teaching, research and training. The agreement confers lead role for the States in promotion of public health. The States acknowledge the Commonwealth’s lead role for effecting reforms in the primary health care. The Commonwealth has agreed to increase its funding for hospitals to 45 % from 1 July 2014 and to 50 % from 1 July 2017. Further, the Commonwealth has guaranteed that the contribution will not be less than $ 16.4 billion during the period from 2014-2015 and 2019-2020. In case of shortfall, the balance will be paid to the national funding body for being distributed to the States. States are expected to spend to meet the additional demand for services such as chronic disease management programs, preventive health programs, mental health programs, hospital admission avoidance programs and hospital early discharge programs. The Commonwealth’s contribution for stimulating growth will be in addition to the existing partnership agreements at the national level and with the private hospitals. From 1 July 2017, the Commonwealth will provide half the increase in costs for providing public hospital services. From 1 July 2011, a National Performance Authority will be set up by a Commonwealth legislation. The authority will submit reports on the performance of hospitals and health care services and primary health care services. (HealthAndAgeingDepartment, 2011) Conclusion It is quite evident that the Australian Health System is founded on the principle of equity of access. The prioritisation of access to services ranging from the coverage of the hitherto neglected native population to the timely access to quality care has been the sincere efforts of health care reforms commission that makes heath care delivery comprehensive. Thus, the native populations apart from receiving necessary care on priority basis, will also be looked after under the other priority areas of mental health care, services to remote and rural areas, dental health care. and timely health care in public hospitals. This ensures vertical and horizontal integration of priorities so that there is not the least chance of any single citizen of being denied of quality and timely health care. This, combined with the active role of the Commonwealth ensures efficiency and connectedness among the health care systems in the country. The entire efforts under the policy frameworks of the WHO and the OECD also add to the efficiency and integrated nature of the heath systems. References Arah, O. A., Westert, G. P., Hurst, J., & Klazinga, N. S. (2006). A conceptual framework for the OECD Health Care Quality Indicators Project. Int. Journal for Quality in Health Care , 16 (1), 5-13. Braveman, P. (2003). Monitoring equity in health and health care: a conecptual framework. J Health Popul Nutr , 21 (3), 181-192. DepartmentOfHealthandAgeing. (2009). A Healthier Future for all Australians- Final Report June 2009. Retrieved April 23, 2011, from http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nhhrc-report-toc~nhhrc-report-execsum~nhhrc-report-tackling HealthAndAgeingDepartment. (2011). National Health Reform. Retrieved April 23, 2011, from Australian Government Department of Health and Ageing : Available at accessed 23 April 2011 Humphreys, J., & Wakerman, J. (n.d ). Primary heath care in rural and remote Australia: achieving equity of access and outcomes through national refrom. Discussion Paper. Muecke, S. (2010). Identifying gaps in primary care services: reaching the 'unreached'. Ressearch Roundup , Available at accessed 23 April 2011. WHO. (2008). The World Health Report 2008. Primary Care now more than ever (Online) , Geneva: World Health Organisation in Muecke S (2010) Identfying gaps in primary care services: reaching the unreached Research Roundup Issue 13 Accessed 23 April 2011. Read More